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Johansen H, Helgesen AK. Palliative care in the community - the role of the resource nurse, a qualitative study. BMC Palliat Care 2021; 20:157. [PMID: 34645424 PMCID: PMC8515638 DOI: 10.1186/s12904-021-00860-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Approaches involving resource nurses have been used in several fields of practice to enhance quality of care. A literature review reveals limited research on the role of the resource nurse in palliative care in the community. AIM To explore experiences related to the role of the resource nurse in palliative care in the setting of nursing homes in Norway. DESIGN The study has an explorative design with a qualitative approach. METHODS Two semi structured group interviews were conducted. Five resource nurses participated in the first interview, two resource nurses participated in the last interview. The group interviews were audiotaped, transcribed verbatim and analysed with systematic text condensation. RESULTS The resource nurses wish to promote high-quality palliative care. They are skilled palliative nurses working clinically, and they use their experience and knowledge to talk about and demonstrate good practice. By conveying knowledge and being role models, they bolster their colleagues' confidence and skills in palliative care and contribute to a shared view of quality. They can potentially play an important role in facilitating reflection and collaboration in the palliative care team. However, the resource nurse's function is affected by interpersonal, managerial and organisational factors. CONCLUSION The resource nurse most important tool in promoting high-quality palliative care may be to support their colleagues being a role model, and sharing knowledge and experience. The resource nurses play an important role in facilitating reflection and collaboration in the palliative care team and may contribute to ethical awareness and proper dialogues about end of life issues.
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Affiliation(s)
- Håkon Johansen
- Faculty of Health and Welfare Sciences, Østfold University College, 1757, Halden, Norway.
| | - Ann Karin Helgesen
- Faculty of Health and Welfare Sciences, Østfold University College, 1757, Halden, Norway
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Connolly M, Ryder M, Frazer K, Furlong E, Escribano TP, Larkin P, Carruthers E, McGuigan E. Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study. BMC Palliat Care 2021; 20:134. [PMID: 34479521 PMCID: PMC8418028 DOI: 10.1186/s12904-021-00834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Special palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.
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Affiliation(s)
- Michael Connolly
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland.
| | - Mary Ryder
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Eileen Furlong
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Teresa Plazo Escribano
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Philip Larkin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eileen Carruthers
- Regional Specialist Palliative Care Services, Louth, Meath, Cavan, and Monaghan, Drogheda, Ireland
| | - Eileen McGuigan
- Regional Specialist Palliative Care Services, Louth, Meath, Cavan, and Monaghan, Drogheda, Ireland
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Kaasalainen S, Brazil K, Ploeg J, Martin LS. Nurses’ Perceptions around Providing Palliative Care for Long-Term Care Residents with Dementia. J Palliat Care 2019. [DOI: 10.1177/082585970702300307] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing palliative care for residents with dementia in long-term care (LTC) settings is problematic due to their declining verbal abilities and related challenges. The goal of this study was to explore nurses’ perceptions around providing palliative care for such residents. Using a qualitative descriptive design, data were gathered from focus groups at three LTC facilities. Participants represented all levels of nursing staff. Concepts that emerged from the data were labelled, categorized, and coded in an iterative manner. Nurses appraise residents’ general deterioration as a main factor in deciding that a resident is palliative. Nurses often employ creative strategies using limited resources to facilitate care, but are challenged by environmental restrictions and insufficient educational preparation. However, nurses said they do not wish for residents to be transferred to a hospice setting, as they wish to grieve with residents and their family members. Nurses aim to facilitate a “good death” for residents with dementia, while trying to manage multiple demands and deal with environmental issues. Supportive and educational initiatives are needed for nursing staff and families of dying residents.
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Affiliation(s)
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University & St. Joseph's Health System Research Network
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton
| | - Lori Schindel Martin
- School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
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Smets T, Pivodic L, Piers R, Pasman HRW, Engels Y, Szczerbińska K, Kylänen M, Gambassi G, Payne S, Deliens L, Van den Block L. The palliative care knowledge of nursing home staff: The EU FP7 PACE cross-sectional survey in 322 nursing homes in six European countries. Palliat Med 2018; 32:1487-1497. [PMID: 29972343 PMCID: PMC6158686 DOI: 10.1177/0269216318785295] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The provision of high-quality palliative care in nursing homes (NHs) is a major challenge and places demands on the knowledge and skills of the staff. AIM This study assesses the palliative care knowledge of staff in NHs in Europe. DESIGN Cross-sectional study using structured survey Setting/participants: Nurses and care assistants working in 322 representative samples of NHs in Belgium, the Netherlands, England, Finland, Poland and Italy. Palliative care knowledge is measured with the Palliative Care Survey. Scores on the scales range between 0 and 1; higher scores indicate more knowledge. RESULTS A total of 3392 NH-staff were given a questionnaire, and 2275 responded (67%). Knowledge of basic palliative care issues ranged between 0.20 in Poland (95% confidence interval (CI) 0.19; 0.24) and 0.61 in Belgium (95% CI 0.59; 0.63), knowledge of physical aspects that can contribute to pain ranged between 0.81 in Poland (95% CI 0.79; 0.84) and 0.91 in the Netherlands (95% CI 0.89; 0.93), and knowledge of psychological reasons that can contribute to pain ranged between 0.56 in England (95% CI 0.50; 0.62) and 0.87 in Finland (95% CI 0.83; 0.90). Factors associated with knowledge were country, professional role and having undertaken formal training in palliative care. CONCLUSIONS Knowledge of nurses and care assistants concerning basic palliative care issues appears to be suboptimal in all participating countries, although there is substantial heterogeneity. Education of nursing staff needs to be improved across, but each country may require its own strategy to address the unique and specific knowledge gaps.
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Affiliation(s)
- Tinne Smets
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Lara Pivodic
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Ruth Piers
- 3 Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - H Roeline W Pasman
- 4 EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvonne Engels
- 5 Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Katarzyna Szczerbińska
- 6 Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marika Kylänen
- 7 National Institute for Health and Welfare, Helsinki, Finland
| | | | - Sheila Payne
- 9 International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Luc Deliens
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,9 International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Lieve Van den Block
- 1 Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Lindley LC. Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care. Am J Hosp Palliat Care 2017; 35:945-950. [PMID: 29169246 DOI: 10.1177/1049909117743181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. OBJECTIVE/HYPOTHESIS This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. METHODS Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. RESULTS The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. CONCLUSIONS The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.
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Affiliation(s)
- Lisa C Lindley
- 1 College of Nursing, University of Tennessee, Knoxville, TN, USA
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6
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A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods. BMC Palliat Care 2016; 15:40. [PMID: 27059019 PMCID: PMC4825074 DOI: 10.1186/s12904-016-0115-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 04/04/2016] [Indexed: 11/26/2022] Open
Abstract
Background Integrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46 % of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96 % had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit –MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago Hospital Methods An evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews. Results A significant difference was seen in nurses’ confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86 %) and referred 334 (14 %) to MPCU. Clinical guidelines/protocols were utilised in 50 % of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013). Conclusion The link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education.
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Baron K, Hodgson A, Walshe C. Evaluation of an advance care planning education programme for nursing homes: A Longitudinal study. NURSE EDUCATION TODAY 2015; 35:689-695. [PMID: 25638279 DOI: 10.1016/j.nedt.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To evaluate the success of a programme of Advance Care Planning education for nursing homes by examining the effect on staff knowledge, Advance Care Planning practice within the home and end-of-life hospital admission rates. METHOD Three longitudinal questionnaires assessing staff knowledge, Advance Care Planning Practice and hospital deaths completed before and after the initiation of the Advance Care Planning education programme by homes that had completed the training and those yet to undergo the training. RESULTS Superior Advance Care Planning knowledge was evident in those staff that had completed the training. There was an increase of 85% in the number of Advance Care Plans completed in the training homes and an overall reduction in hospital deaths of 25% for residents from training homes. CONCLUSION A programme of Advance Care Planning education for nursing homes is successful in improving nursing home staff knowledge, increasing Advance Care Planning practice and reducing hospital deaths.
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Affiliation(s)
- Kirsten Baron
- Wigan and Leigh Hospice, Kildare St., Wigan, Greater Manchester WN2 3HZ, United Kingdom.
| | - Aruna Hodgson
- Wigan and Leigh Hospice, Kildare St., Wigan, Greater Manchester WN2 3HZ, United Kingdom
| | - Catherine Walshe
- Division of Health Research, Furness Building, Lancaster University, Lancaster LA1 4YG, United Kingdom
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Kaasalainen S, Ploeg J, McAiney C, Schindel Martin L, Donald F, Martin-Misener R, Brazil K, Taniguchi A, Wickson-Griffiths A, Carter N, Sangster-Gormley E. Role of the nurse practitioner in providing palliative care in long-term care homes. Int J Palliat Nurs 2013; 19:477-85. [PMID: 24162278 DOI: 10.12968/ijpn.2013.19.10.477] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The purpose of this study, which was part of a large national case study of nurse practitioner (NP) integration in long-term care (LTC), was to explore the NP role in providing palliative care in LTC. METHODS Using a qualitative descriptive design, data was collected from five LTC homes across Canada using 35 focus groups and 25 individual interviews. In total, 143 individuals working in LTC participated, including 9 physicians, 20 licensed nurses, 15 personal support workers, 19 managers, 10 registered nurse team managers or leaders, 31 allied health care providers, 4 NPs, 14 residents, and 21 family members. The data was coded and analysed using thematic analysis. FINDINGS NPs provide palliative care for residents and their family members, collaborate with other health-care providers by providing consultation and education to optimise palliative care practices, work within the organisation to build capacity and help others learn about the NP role in palliative care to better integrate it within the team, and improve system outcomes such as accessibility of care and number of hospital visits. CONCLUSIONS NPs contribute to palliative care in LTC settings through multifaceted collaborative processes that ultimately promote the experience of a positive death for residents, their family members, and formal caregivers.
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Affiliation(s)
- Sharon Kaasalainen
- Associate Professor, School of Nursing, McMaster University, Ontario, Canada
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10
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Arcand M, Brazil K, Nakanishi M, Nakashima T, Alix M, Desson JF, Morello R, Belzile L, Beaulieu M, MPM Hertogh C, T van der Steen J, Toscani F. Educating families about end-of-life care in advanced dementia: acceptability of a Canadian family booklet to nurses from Canada, France, and Japan. Int J Palliat Nurs 2013; 19:67-74. [DOI: 10.12968/ijpn.2013.19.2.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marcel Arcand
- Research Center on Ageing, Sherbrooke (CDRV), and Department of Family Medicine, University of Sherbrooke, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | | | - Taeko Nakashima
- Institute for Health Economics and Policy (IHEP) Tokyo, Japan
| | - Michel Alix
- Département de Gériatrie et de Gérontologie, Centre Hospitalier de La Rochelle, France
| | | | - Rémy Morello
- Unite de Biostatistique et Recherche Clinique, Centre Hospitalier Universitaire de Caen, France
| | | | | | | | - Jenny T van der Steen
- EMGO Institute for Health and Care Research, Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Franco Toscani
- Lino Maestroni-Palliative Medicine Research Institute, Cremona, Italy
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11
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An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation. Int J Nurs Stud 2012; 49:586-95. [PMID: 22130508 DOI: 10.1016/j.ijnurstu.2011.10.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/12/2011] [Accepted: 10/20/2011] [Indexed: 11/23/2022]
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12
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Hov R, Hedelin B, Athlin E. Nursing care for patients on the edge of life in nursing homes: obstacles are overshadowing opportunities. Int J Older People Nurs 2012; 8:50-60. [DOI: 10.1111/j.1748-3743.2011.00306.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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McIlfatrick S, Mawhinney A, Gilmour F. Assessing the educational needs of palliative care link nurses. Int J Palliat Nurs 2010; 16:555-9. [DOI: 10.12968/ijpn.2010.16.11.80198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Fiona Gilmour
- Northern Health and Social Care Trust, BT37 OQB, Northern Ireland
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14
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Fleming J, Zhao J, Farquhar M, Brayne C, Barclay S. Place of death for the 'oldest old': > or =85-year-olds in the CC75C population-based cohort. Br J Gen Pract 2010; 60:171-9. [PMID: 20353663 PMCID: PMC2845508 DOI: 10.3399/bjgp10x483959] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce. AIM To examine the place of residence or care of > or =85 year-olds less than a year before death, and their place of death, and to map individual changes between the two. DESIGN OF STUDY Population-based cohort study. SETTING Cambridge City over-75s Cohort (CC75C) study, UK. METHOD Retrospective analysis of prospective data from males and females aged > or =85 years at death who died within a year of taking part in any CC75C survey (n = 320); death certificate linkage. RESULTS Only 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes. CONCLUSION More than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old.
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Affiliation(s)
- Jane Fleming
- Institute of Public Health, University of Cambridge, Cambridge.
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Rees Y, Jones S, Parry M. Implementation and evaluation of a palliative care resource scheme within a district general hospital. Int J Palliat Nurs 2009; 15:481-6. [DOI: 10.12968/ijpn.2009.15.10.44885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article explores the development, implementation and evaluation of a palliative care resource scheme in a district general hospital in Mid Gamorgan, Wales. The evolution of the resource scheme and how the hospital specialist palliative care team identified the need for improved patient care on hospital wards is discussed, in addition to how using their specialist role combined with education can implement change. The project evolved from initially recruiting two nurses on an in-house educational programme, to what has since become a formal arrangement with the local university, whereby students can access taught palliative care modules at degree and diploma levels as part of a distance learning degree in cancer care and a distance learning post-graduate certificate in palliative care. The resource enhances the knowledge of the practitioners who have completed it and also formalizes and expands the working links between education and clinical practice. It is hoped to continue and develop the scheme to further enhance the collaborative partnerships.
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Affiliation(s)
- Yvonne Rees
- Palliative Care, Cwm Taf Local Health Board, Prince Charles Hospital, Merthyr Tydfil
| | - Sian Jones
- Division of Acute and Specialised Care, Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, CF37 1DL
| | - Maria Parry
- Division of Acute and Specialised Care, Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, CF37 1DL
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Badger F, Clifford C, Hewison A, Thomas K. An evaluation of the implementation of a programme to improve end-of-life care in nursing homes. Palliat Med 2009; 23:502-11. [PMID: 19477886 DOI: 10.1177/0269216309105893] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre-post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that returned pre- and post-data demonstrated improvements in aspects of end-of-life care. There were statistically significant increases in the proportion of residents who died in the care homes and those who had an advanced care plan. Crisis admissions to hospital were significantly reduced. This evaluation indicates that appropriately funded structured programmes have the potential to assist nursing homes improve the provision of end-of-life care to older adults, in line with government health policy.
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Affiliation(s)
- F Badger
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
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17
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Pavlish C, Ceronsky L. Oncology Nurses' Perceptions of Nursing Roles and Professional Attributes in Palliative Care. Clin J Oncol Nurs 2009; 13:404-12. [DOI: 10.1188/09.cjon.404-412] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Heals D. Development and implementation of a palliative care link-nurse programme in care homes. Int J Palliat Nurs 2008; 14:604-9. [DOI: 10.12968/ijpn.2008.14.12.32065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hasson F, Kernohan WG, Waldron M, Whittaker E, McLaughlin D. The palliative care link nurse role in nursing homes: barriers and facilitators. J Adv Nurs 2008; 64:233-42. [PMID: 18785884 DOI: 10.1111/j.1365-2648.2008.04803.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study to explore link nurses' views and experiences regarding the development, barriers and facilitators to the implementation of the role in palliative care in the nursing home. BACKGROUND The delivery of palliative care in nursing homes is widely advocated; one approach is to develop the link nurse role to cascade good practice and training to nurses and other care staff to enhance patient care. METHOD A descriptive qualitative study was conducted with a purposive sample of 14 link nurses from 10 nursing homes in Northern Ireland during 2006. Three focus groups, composed of all Registered Nurses currently acting as link nurses in their nursing homes participated, and the data were audio recorded, fully transcribed and content analysed. FINDINGS The link nurse system shows potential to enhance palliative care within nursing homes. However, link nurses experienced a number of difficulties in implementing education programmes. Facilitators of the role included external support, monthly meetings, access to a resource file and peer support among link nurses themselves. Lack of management support, a transient workforce and lack of adequate preparation for link nurses were barriers to fulfilling this role. CONCLUSION Whilst palliative care link nurses can improve care for residents in nursing homes, consideration must be given to overcome the types of barriers identified in order to enable the link nurse system to function effectively.
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Affiliation(s)
- Felicity Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, UK.
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Waldron M, Hasson F, Kernohan WG, Whittaker E, McClaughlin D. Evaluating education in palliative care with link nurses in nursing homes. ACTA ACUST UNITED AC 2008; 17:1078-83. [DOI: 10.12968/bjon.2008.17.17.31104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Waldron
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey
| | - F Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey
| | - WG Kernohan
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey
| | - E Whittaker
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast
| | - D McClaughlin
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast
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21
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Phillips JL, Davidson PM, Jackson D, Kristjanson LJ. Multi-faceted palliative care intervention: aged care nurses' and care assistants' perceptions and experiences. J Adv Nurs 2008; 62:216-27. [PMID: 18394034 DOI: 10.1111/j.1365-2648.2008.04600.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study to describe residential aged care nurses' and care assistants' perceptions of a multi-faceted palliative care intervention to identify potential areas to be addressed during subsequent action research phases. BACKGROUND Action research was used to enhance the delivery of a palliative approach in residential aged care. The chronic care model guided the development of a multi-faceted intervention. This involved the: (1) establishment of a 'link nurse' role; (2) learning and development strategies for nurses, care assistants and general practitioners; (3) use of multi-disciplinary team meetings; and (4) access to specialist consultation. METHOD A purposive sample (n = 28) of aged care nurses and care assistants participated in a series of four focus groups conducted in July 2005. Thematic content analysis of the transcripts was performed. FINDINGS Four themes emerged: (1) targeted education can make a difference; (2) a team approach is valued; (3) clinical assessment tools are helpful; and (4) using the right language is essential. Participants described increased understanding of palliative care concepts, enhanced competencies, greater confidence to deliver palliative care and a desire to adopt a multi-disciplinary approach to care planning. CONCLUSION Sustaining a culture that is committed to ongoing learning and development interventions and creating multi-disciplinary teams in the aged care setting is critical to embedding a palliative approach. The chronic care model is a useful framework to guide the development of interventions leading to better palliative care outcomes for residents and their families.
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Affiliation(s)
- Jane L Phillips
- School of Nursing, Family and Community Health, University of Western Sydney, New South Wales, Australia.
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22
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Byron S, Moriarty D, O'Hara A. Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care. Int J Palliat Nurs 2008; 13:438-44. [PMID: 18026062 DOI: 10.12968/ijpn.2007.13.9.27416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM to describe how a link nurse system for palliative care was established in primary care and report on an evaluation of the system undertaken as part of a larger evaluation of newly established Macmillan nurse facilitator posts. METHOD a range of data collection techniques was used to collect information relating to the link nurse system including interview, questionnaire and observation. Various sampling strategies were adopted for the different data collection methods. This paper reports on the findings of semi structured interviews with groups of district nurses and link nurses, a questionnaire to district nurses, telephone interviews with a sample of questionnaire respondents and site observations. FINDINGS the Macmillan nurse facilitators have established, supported and maintained a robust palliative resource nurse (PRN) group within primary care. The majority of practising clinical district nursing staff have used this important resource for a variety of reasons over the past four years. The model developed provides an opportunity for professional development for the PRNs. This initiative has been viewed as a very positive development and has been utilised for disseminating information, research and audit purposes from clinicians both within and out-with primary care. CONCLUSIONS The establishment of a palliative resource network within primary care has been successful. It has provided an effective and efficient means of disseminating information across a large workforce and extensive geographical area. The development of a clear structured model benefits both the PRNs and the organisation by providing clear expectations of the role while offering a framework for professional development.
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Affiliation(s)
- Shirley Byron
- Greater Glasgow NHS, Primary Care Division, Glasgow, UK.
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23
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Trotta RL. Quality of Death: A Dimensional Analysis of Palliative Care in the Nursing Home. J Palliat Med 2007; 10:1116-27. [DOI: 10.1089/jpm.2006.0263] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca L. Trotta
- Hartford Center of Geriatric Nursing Excellence, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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24
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Cotterell P, Lynch C, Peters D. Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital? Int J Palliat Nurs 2007; 13:102-8. [PMID: 17505402 DOI: 10.12968/ijpn.2007.13.3.23271] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With 90% of people needing some inpatient hospital care in the final year of life, it is evident that the provision and awareness of palliative care, and education surrounding this, are widely needed. This study aims to evaluate a palliative care link nurse initiative (PCLN) in an NHS acute hospital, identifying key factors affecting link nurses' ability to influence palliative care practice. This qualitative study used semi-structured interviews and a focus group to show the anticipated and actual influence of link nurses on practice. Findings suggest that link nurses had increased knowledge and skills in palliative care due to education provided. Link nurses were seen to have an influence on the presence and quality of palliative care practice in hospital wards. Factors that could help link nurses to have greater influence are reported, as are difficulties in providing care and accessing training.
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Affiliation(s)
- Phil Cotterell
- Worthing and Southlands Hospitals NHS Trust, Worthing, West Sussex, UK.
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25
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Whittaker E, George Kernohan W, Hasson F, Howard V, McLaughlin D. Palliative care in nursing homes: exploring care assistants? knowledge. Int J Older People Nurs 2007; 2:36-44. [DOI: 10.1111/j.1748-3743.2007.00038.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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McCormack B, Wright J, Dewar B, Harvey G, Ballantine K. A realist synthesis of evidence relating to practice development: findings from the literature analysis. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/pdh.211] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Ternestedt BM, Franklin LL. Ways of relating to death: views of older people resident in nursing homes. Int J Palliat Nurs 2006; 12:334-40. [PMID: 16926732 DOI: 10.12968/ijpn.2006.12.7.21611] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Few studies shed light on what older people themselves consider a good or dignified death. This study is part of a larger project where interviews were used to follow 12 nursing home residents over time. The aim of the present study was to reach a deeper understanding of seven older people's thoughts, feelings and attitudes towards death. The participants were interviewed on four occasions across 18-24 months, and the interviews were analysed using a hermeneutic method. The findings revealed three main themes: 1. Zest for life, 2. Indifferent attitude, 3. Longing for death. The themes mirror the complexity of what ageing and nearing the end of life can mean. A strong desire among the participants was to be more involved in their own personal care and in everyday life at the nursing home. Person-oriented care based on the philosophy of palliative care, and including conversation as a natural component, might promote the older person's possibilities to obtain a good death.
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28
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Whittaker E, George Kernohan W, Hasson F, Howard V, McLaughlin D. The palliative care education needs of nursing home staff. NURSE EDUCATION TODAY 2006; 26:501-10. [PMID: 16517029 DOI: 10.1016/j.nedt.2006.01.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 12/22/2005] [Accepted: 01/13/2006] [Indexed: 05/06/2023]
Abstract
BACKGROUND Palliative care is delivered in a number of settings, including nursing homes, where staff often have limited training in palliative care. AIM We explored the level of palliative care knowledge among qualified staff delivering end-of-life care in nursing home settings, to inform the development of an appropriate education and training programme. DESIGN An audit of the educational needs assessment was performed using an anonymous postal questionnaire sent to 528 qualified nursing staff within 48 nursing homes. FINDINGS In total, 227 questionnaires were returned giving a response rate of 43%. Results indicated that less than half the sample had obtained formal training in the area of pain assessment and management and less than a quarter had obtained training in non-malignant conditions. Registered nurses in this study reported a lack of awareness of palliative care principles or national guidelines. CONCLUSION Qualified nursing home staff agree that palliative care is a valuable model for care in their setting. There are clear opportunities for improvement in nursing home care, based on education and training in palliative care. Results also support the need for enhanced liaison between nursing homes and specialist palliative care services.
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Affiliation(s)
- Evelyn Whittaker
- Northern Ireland Hospice, 71A Saintfield Road, Belfast, BT8 7HN, United Kingdom.
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29
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Phillips J, Davidson PM, Jackson D, Kristjanson L, Daly J, Curran J. Residential aged care: the last frontier for palliative care. J Adv Nurs 2006; 55:416-24. [PMID: 16866837 DOI: 10.1111/j.1365-2648.2006.03945.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper is a report of an explorative study describing the perceptions and beliefs about palliative care among nurses and care assistants working in residential aged care facilities in Australia. BACKGROUND Internationally, the number of people dying in residential aged care facilities is growing. In Australia, aged care providers are being encouraged and supported by a positive policy platform to deliver a palliative approach to care, which has generated significant interest from clinicians, academics and researchers. However, a little is known about the ability and capacity of residential aged care services to adopt and provide a palliative approach to care. METHODS Focus groups were used to investigate the collective perceptions and beliefs about palliative care in a convenience sample of nurses and care assistants working in residential aged care facilities in Australia. Thematic content analysis was used to analyse the data, which were collected during 2004. RESULTS Four major themes emerged: (1) being like family; (2) advocacy as a key role; (3) challenges in communicating with other healthcare providers; (4) battling and striving to succeed against the odds. Although participants described involvement and commitment to quality palliative care, they also expressed a need for additional education and support about symptom control, language and access to specialist services and resources. CONCLUSION The residential aged care sector is in need of support for providing palliative care, yet there are significant professional and system barriers to care delivery. The provision of enhanced palliative care educational and networking opportunities for nurses and care assistants in residential aged care, augmented by a supportive organizational culture, would assist in the adoption of a palliative approach to service delivery and requires systematic investigation.
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Affiliation(s)
- Jane Phillips
- Mid-North Coast, NSW, Division of General Practice, School of Nursing, Family and Community Health, University of Western Sydney, Sydney, Australia.
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30
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Abbey J, Froggatt K, Parker D, Abbey B. Palliative care in long-term care: a system in change. Int J Older People Nurs 2006; 1:56-63. [DOI: 10.1111/j.1748-3743.2006.00010.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Froggatt KA, Wilson D, Justice C, MacAdam M, Leibovici K, Kinch J, Thomas R, Choi J. End-of-life care in long-term care settings for older people: a literature review. Int J Older People Nurs 2006; 1:45-50. [DOI: 10.1111/j.1748-3743.2006.00008.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This article illustrates the planning, implementation, evaluation and personal implications of a link-nurse programme for colorectal cancer nursing. The programme was designed to maintain a patient-centred support service and continue the provision of bowel cancer education and support to nurses in the clinical environment. Literature on previous link-nurse schemes, and the recent legislation on education and cancer nursing provides the background on which this programme is based. The use of educational theory supplies the theoretical underpinnings for this approach to learning, and evaluation findings are reported from both the group's and the individual's viewpoints. The programme increased the link nurses' awareness of the patient's pathway, support and information needs and the role of the multidisciplinary team in managing care. Sufficient time, support and encouragement from ward teams and clinical managers were seen as vital to the success of the programme, and specific benefits and challenges when establishing this type of practice based education for nurses are explored.
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33
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Chang E, Hancock K, Harrison K, Daly J, Johnson A, Easterbrook S, Noel M, Luhr-Taylor M, Davidson PM. Palliative care for end-stage dementia: a discussion of the implications for education of health care professionals. NURSE EDUCATION TODAY 2005; 25:326-32. [PMID: 15885857 DOI: 10.1016/j.nedt.2005.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2005] [Indexed: 05/02/2023]
Abstract
The increasing burden of chronic disease demands that palliative care clinicians address the needs of patients with non-malignant disease. This discussion document seeks to address some of the challenges to providing palliative care for end-stage dementia (ESD) and the need for skill enhancement in key providers of care. In spite of the intent, there is an apparent lack of appropriate, co-ordinated and comprehensive palliative care available for these individuals and their families. There is an absence of well-articulated models to assist health care providers of ESD clients. It would appear that the development and evaluation of guidelines, implementation of education programs and collaborative associations between palliative and aged-care providers of care are key strategies to facilitate palliative care for ESD clients.
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Affiliation(s)
- Esther Chang
- School of Nursing, Family and Community Health, College of Social & Health Sciences, University of Western Sydney, Parramatta Campus, Penrith South, Australia
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34
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Goodman C, Woolley R, Knight D. District nurse involvement in providing palliative care to older people in residential care homes. Int J Palliat Nurs 2003; 9:521-7. [PMID: 14765008 DOI: 10.12968/ijpn.2003.9.12.11987] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although less than 15% of older people in care homes die of a terminal disease such as cancer, many more die following a period of slow deterioration. In the UK, residents of care homes receive their nursing care from primary healthcare providers. This article reports on a study that describes how district nurses and care home managers define their responsibilities when caring for residents who are dying. The findings presented are from a detailed survey of 89 district nurse team leaders and 96 care home managers. District nurses were the most frequent health professionals visiting care homes, but less than half reported involvement in palliative care. The differing priorities and perceptions of participants regarding what constituted nursing and personal care influenced older people's access to palliative care services. Furthermore, the organization of care and the stability of the care home workforce affected participants' ability to establish ongoing supportive working relationships. It is argued that unless there is an organizational review of current practice, older people will continue to have unequal access to generalist and specialist palliative care.
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Affiliation(s)
- Claire Goodman
- Primary Care Nursing Research Unit, Department of Primary Care and Population Sciences, University College London, Archway Campus, Level 2 Holborn Union Building, Highgate Hill, London N19 5LW, UK.
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35
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Nolan M, Featherston J, Nolan J. Palliative care philosophy in care homes: lessons from New Zealand. ACTA ACUST UNITED AC 2003; 12:974-9. [PMID: 14508421 DOI: 10.12968/bjon.2003.12.16.11446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2003] [Indexed: 11/11/2022]
Abstract
Increasing numbers of people are dying in care homes yet little is known about the nature and quality of their deaths. The limited research available suggests that there is a need to promote a philosophy of palliative care that is not confined to the terminal phase of life. However, adopting such an approach appears to be inhibited by a lack of understanding, education and training, as well as continuing reluctance to discuss issues of death and dying in an open and honest way. Drawing on data from a large convenience sample of caregivers in New Zealand, this article argues for a reappraisal of the way in which care homes view death and dying and advocates the more widespread adoption of a palliative care philosophy.
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Affiliation(s)
- Mike Nolan
- School of Nursing and Midwifery, University of Sheffield
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